A crying liver: a scan pattern mimicking spontaneous perforation of the biliary ducts

A 2-month-old infant was referred for hepatobiliary scintigraphy due to ascites of unknown cause. The top differential diagnosis was spontaneous perforation of the biliary ducts. Delayed images up to 4 hours were against this diagnosis showing normal distribution of the radiotracer throughout the bo...

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Bibliographic Details
Published in:Nuclear medicine review. Central & Eastern Europe 2022-01, Vol.25 (2), p.131-133
Main Authors: Barashki, Somaye, Mohammadzadeh Kosari, Hadis, Askari, Emran, Bakhshi Golestani, Zahra, Hiradfar, Mehran, Sadeghi, Ramin
Format: Article
Language:English
Subjects:
Abdomen
Abdominal surgery
Ascites
Bile ducts
Conflicts of interest
Cysts
Liver
Nuclear medicine
Pediatrics
Scintigraphy
Tomography
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Summary:A 2-month-old infant was referred for hepatobiliary scintigraphy due to ascites of unknown cause. The top differential diagnosis was spontaneous perforation of the biliary ducts. Delayed images up to 4 hours were against this diagnosis showing normal distribution of the radiotracer throughout the bowel. However, on delayed images, the scan showed mild tracer retention in the ascites confirmed by SPECT/CT images. Surprisingly, the exploratory abdominal surgery revealed an intact hepatobiliary system, pointing toward other possible etiologies. Second-review surgery was performed due to uncontrolled progressive ascites showing congestive hepatopathy and biliary leak from the hepatic surface suggestive of the “crying liver”.
ISSN:1506-9680
1644-4345
DOI:10.5603/NMR.a2022.0028